The COVID-19 pandemic has resulted in large-scale changes to the National Health Service (NHS) systems in the UK to accommodate a predicted surge in acutely unwell adults presenting to emergency and critical care departments. National media campaigns reinforced this public health policy in asking families to stay at home to avoid spreading the infection. Early international reports indicated that as a result, some parents and carers were bringing their children to hospital later than they would previously have done so, resulting in avoidable morbidity and mortality. 1 Changes were promptly made to NHS 111 (a non-emergency medical helpline) algorithms (Kenny S, NHS England, personal communication) and a simultaneous campaign was run by the Royal College of Paediatrics and Child Health (RCPCH) to highlight redflag symptoms (high risk) and amberflag symptoms (intermediate risk) in children that should prompt a medical review. The effect of media messaging on parental choices to access care is unknown.

Here, we describe a rapid, multicentre surveillance project with three main aims:(1) to identify the number of children with delayed presentations to hospital in large emergency departments;(2) to find out what proportion of these delays was due to hesitance of parents in attending versus the proportion that was due to advice from primary care staff or NHS 111 referrals; and (3) to find out whether these delays might have resulted in harm to children (using admission to hospital as a proxy). Paediatric Emergency Research United Kingdom and Ireland, a network of more than 60 children’s emergency departments, identified member sites that were willing to do the service evaluation. The